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首页> 外文期刊>The Internet Journal of Oncology >Letter to the editor: Otologic Complications Of Radiotherapy In Nasopharyngeal Carcinoma: Usefulness Of Pre-Therapy Grommet Insertion
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Letter to the editor: Otologic Complications Of Radiotherapy In Nasopharyngeal Carcinoma: Usefulness Of Pre-Therapy Grommet Insertion

机译：致编辑的信：鼻咽癌放疗的耳部并发症：治疗前索环插入的有用性

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摘要

Nasopharyngeal carcinoma (NPC) is often managed by megavoltage radiotherapy (RT). However, both NPC (5) and RT (4) are associated with the risk of developing otitis media with effusion (OME). Since the introduction of grommet (ventilation tube) by Armstrong in 1954 (1) its usage following myringotomy became a common practice for the management of OME. Several investigators also recommended that patients with NPC treated with RT should have the accompanying secretory otitis media treated with grommet insertion (2,8). These studies emphasized the audiological success of middle ear ventilation but without any commentary on the complications arising from grommet insertion. Later, Skinner and van Hasselt (7) clearly showed significantly greater complications with grommet insertion in NPC patients as compared to control group. Although myringotomy with grommet insertion is considered an acceptable method of management of patients with secretory otitis media the clinical advantage of the use of grommet for the treatment of OME in patients who had received RT for NPC is still a matter of debate. Overall, there is no general agreement if grommet should be used for the treatment of OME in NPC patients who received RT. The purpose of this study was to compare otologic complications in 50 adult NPC patients (mean age, 41 years, range = 16-80 years; male:female ratio, 4:1) who received conservative treatment (N=16) or surgical intervention in the form of grommet insertion before (N=23) or after (N=11) external beam radiotherapy (dose, 70-75 Gy over a period of 6 weeks). The selection criteria and grouping of patients were based on the presentation of disease. The NPC patients who presented with the symptoms of significant hearing loss and ear blockade accompanied by OME received myringotomy and grommet insertion to relieve their symptom and to avoid risk of spontaneous tympanic membrane perforation and subsequent infection even before radiating them. As both NPC and RT may initiate/aggravate OME with subsequent hearing loss and ear blockade such cases were categorized for myringotomy plus grommet insertion post-radiotherapy. Whereas the conservative treatment (hearing aids and pharmacotherapy for infection/inflammation) was intended to avoid the chronic complications associated with grommet insertion that might outweigh its short-term benefits. The incidence of complications including otorrhoea, hearing impairment and perforation of tympanic membrane was recorded in all the treatment groups. The mean follow-up period in this study was 4 years and 4 months. Out of total 16 patients who received conservative treatment following RT, the incidence of otorrhoea, perforation of tympanic membrane, and hearing impairment were observed in 31%, 38% and 56% of the patients, respectively (Fig. 1). In the patients who were inserted with grommet before radiotherapy, otorrhoea was observed in 35% of cases, perforation of tympanic membrane in 17%, and hearing impairment was recorded in 48% of patients. On the other hand, for the patients, who were inserted with grommet after the radiotherapy, the incidence of otorrhoea and perforation were 27% and 36% respectively, however, a very high percentage of patients (91%) suffered from hearing impairment.
机译：鼻咽癌（NPC）通常通过高压放射疗法（RT）进行治疗。但是，NPC（5）和RT（4）都与发生积液性中耳炎（OME）的风险有关。自从1954年阿姆斯特朗（Armstrong）引入索环（通风管）以来（1），在开颅手术后使用索环已成为OME管理的一种普遍做法。几位研究者还建议接受RT治疗的NPC患者应伴有索环插入治疗伴发的分泌性中耳炎（2,8）。这些研究强调了中耳通气在听力学上的成功，但没有对因插入索环而引起的并发症发表任何评论。后来，与对照组相比，Skinner和van Hasselt（7）清楚地表明，在NPC患者中插入索环的并发症明显更大。尽管开孔套管插入式开髓手术被认为是治疗分泌性中耳炎患者的一种可接受的方法，但是在接受了鼻咽癌放疗的患者中使用开孔套管治疗OME的临床优势仍然是一个争论的问题。总体而言，对于接受RT的NPC患者是否应使用索环治疗OME尚无普遍共识。这项研究的目的是比较50例接受保守治疗（N = 16）或手术干预的成人NPC患者（平均年龄41岁，范围= 16-80岁;男性与女性的比例为4：1）的耳科并发症。以束环插入的形式在外部束放射治疗之前（N = 23）或之后（N = 11）（剂量，在6周内为70-75 Gy）。选择标准和患者分组基于疾病的表现。伴有OME并伴有严重听力下降和耳部阻塞症状的NPC患者接受开颅手术和索环插入以缓解症状并避免自发性鼓膜穿孔和随后感染的危险，甚至在放疗前也是如此。由于NPC和RT均可能引发OME或加重OME，继而导致听力损失和耳部阻塞，因此将这些病例归类为放疗后进行开颅加索环插入。保守治疗（用于感染/发炎的助听器和药物疗法）旨在避免与套管插入相关的慢性并发症，这种并发症可能会超过其短期收益。在所有治疗组中记录了并发症的发生率，包括耳炎，听力障碍和鼓膜穿孔。本研究的平均随访期为4年零4个月。在放疗后接受保守治疗的16例患者中，分别有31％，38％和56％的患者观察到耳漏，鼓膜穿孔和听力障碍的发生率（图1）。在放疗前插入索环的患者中，发现35％的患者出现耳炎，17％的鼓膜穿孔，48％的患者出现听力障碍。另一方面，对于放疗后插入索环的患者，耳漏和穿孔的发生率分别为27％和36％，但是，有很高比例的患者（91％）患有听力障碍。

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